The present invention relates to surgical repair of meniscal tears, and more particularly to a unique arthroscopic handheld device and methods for repairing meniscal tears by passing suture within the meniscus through the tear.
There are two meniscuses in each knee, the medial meniscus, and the lateral meniscus, each of which comprises fibrocartilage. The meniscuses protect the articular cartilage on the surfaces of the femur and the tibia. Historically, torn portions of a meniscus were simply surgically removed. However, over time, it has become known in the field that removing substantial portions of the meniscus often accelerates the onset of osteoarthritis and other complications which develop when the shock absorbing meniscuses in the knee are absent. Most tears of the meniscus do not heal on their own, because of a very limited blood supply, but, using modern techniques, many tears can be surgically repaired, thus avoiding the need to remove meniscal portions.
Current meniscal repair methods and devices include both open surgical and arthroscopic techniques. Some repair approaches utilize suture only, others utilize anchors only, while still others are hybrid techniques which employ both suture and anchor devices.
Traditional early prior art arthroscopic meniscal repair methods began with a complicated suture only, “inside outside” technique. These techniques involved several access ports into the surgical site, and several instrument exchanges during the procedure, increasing surgical time and complexity. Because of this, the required surgical skill to effectively execute these arthroscopic procedures was quite high. A benefit to the early conventional methods were that only suture was left behind, thus eliminating the risk of loose bodies in the knee space as well as abrasion to the articular cartilage from hard plastic or metal implants.
A later surgical technique that was developed involved a plastic implant with no suture. The implant had a dart shape to it with barbs that, when inserted into the meniscus, would resist backing out. A benefit to this type of technology was that it didn't require numerous ports or instrument exchanges. This was a much easier method than the suture-only method discussed above. The downside was that it left a plastic head in the articular space which caused abrasion to the femoral condyle articular cartilage.
A still later conventional meniscal repair technique that has been developed is a hybrid involving both an implant and suture. The benefit to this hybrid approach is that the practitioner gained the ease of the implant technique, as discussed above, but there was no exposed plastic implant in the articular space. The downside risk that still exists with this approach is that of a hard plastic loose body remaining at the procedural site. Should some sort of failure occur, the hard plastic implant may come loose and cause damage in the articular space.
What is needed, therefore, is an arthroscopic meniscal repair system and technique which combines the ease of the prior art implant procedures, while eliminating the risk that comes with a hard plastic implant.